We carried out an unannounced comprehensive inspection of this service between 28 November 2017 and 22 January 2018. Breaches of legal requirements were found in relation to Regulations 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3).

Because of our concerns the Care Quality Commission acted in response to our findings by rating the service as ‘Requires Improvement’ and serving two Warning Notices on 13 March 2018, relating to breaches of Regulation 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3). The warning notices referred to recruitment practices at the service not being safe and not all records as required by regulation being sought. Additionally, newly employed staff had not received a robust induction and the majority of staff employed at the service had not received appropriate training, formal supervision or an appraisal of their overall performance. The dates for compliance to be achieved were 1 May 2018 and 1 July 2018, respectively. The registered provider’s quality assurance arrangements were not as robust as they should be as the above breaches of regulation and required improvements had not been identified.

After the comprehensive inspection, the registered provider wrote to us to say what they would do to meet legal requirements, and told us they would be compliant by the above dates.

We undertook this focused inspection on 13 August 2018 to check that the registered provider had followed their action plan and to confirm they now met legal requirements. We inspected the service against three of the five questions we ask about services: is the service ‘Safe’, ‘Effective’ and ‘Well-Led’? This is because the service was not meeting some legal requirements. We found that action had been taken to improve the service’s safety, effectiveness and well-led arrangements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Allied Care and Nursing Ltd on our website at www.cqc.org.uk

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing. It provides a service for older adults living within Southend-on-Sea. The domiciliary care agency office is in close proximity to all major bus and train routes.

The registered provider was also the registered manager and they delegated some of the day-to-day running of the service to a human resources [HR] manager and an administrator. They were also supported by a ‘homecare’ manager and care coordinator. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Our key findings across the areas we inspected were as follows:

Recruitment procedures were now followed to ensure the right staff were employed and all records as required by regulation sought.

Staff now received a thorough induction to carry out their role and responsibilities effectively. Staff had the right competencies and skills to meet people’s needs and received regular training opportunities, both mandatory and in specialist areas. Suitable arrangements were also now in place for staff to receive regular formal supervision and staff employed longer than 12 months had received an appraisal of their overall performance.

Suitable arrangements were in place to assess and monitor the quality of the service provided. The HR manager and administrator demonstrated a good knowledge and understanding of regulatory requirements and the fundamental standards. Where areas for improvement had previously been highlighted, t

The inspection was completed on the 28 and 29 November 2017, 12 December 2017, 10 and 22 January 2018 and was announced. At the time of this inspection there were 45 people receiving a service from Allied Care & Nursing Ltd.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service for older adults living within Southend on Sea. The domiciliary care agency office is in close proximity to all major bus and train routes.

At the last inspection on the 5 and 6 December 2016 and 11 January 2017, the service was rated ‘Requires Improvement ’. A breach of regulatory requirements was evident for Regulation 12 [Safe care and treatment], Regulation 13 [Safeguarding service users from abuse and improper treatment], Regulation 17 [Good governance], Regulation 18 [Staffing] and Regulation 19 [Fit and proper persons employed]. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question of ‘Safe’, ‘Effective’, ‘Responsive’ and ‘Well-Led’ to at least good. The action plan was received detailing the improvements they intended to make. At this inspection, we found the service remained rated ‘Requires Improvement’. This is the second time the service has been rated ‘Requires Improvement’.

The registered provider was also the registered manager. The registered provider had delegated the day-to-day running of the service to the newly appointed care manager. The latter was previously the care coordinator. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff recruitment practices required significant strengthening as not all records had been sought. Newly employed staff had not received a comprehensive induction. This included induction for staff where they had been promoted to a different role. Not all staff had received mandatory training or other specialist training to meet people’s needs. Staff had not received regular formal supervision and where this was in place, staff did not feel it was ‘fit for purpose’.

Effective robust arrangements were not always in place to assess and monitor the quality of the service. Quality assurance systems had failed to identify the issues we found during our inspection to help drive and make all of the necessary improvements required to achieve compliance with regulatory requirements and the registered provider’s own policies and procedures.

Although there was no impact to suggest that people’s care and support needs were not being met, not all risks to people’s health, welfare and safety had been identified. Improvements were required to guide staff in the steps they should take to mitigate risks to ensure people’s safety and wellbeing.

Although people told us that staff provided care and support that was kind and caring, not all arrangements were as effective as they should be and if not monitored carefully, could potentially impact on the delivery of care people received. This referred specifically to the deployment of staff not always being appropriate and staff attending to people on their own despite the person using the service being assessed as requiring two members of staff.

Suitable arrangements were in place to keep people safe. Policies and procedures were followed by staff to safeguard people and staff understood these measures. People were protected by the registered provider’s arrangements for the prevention and control of infection despite not all staff having attained training in this subject. Arrangements were in place for learning and when things go wrong.

People’s nutritional and hydration needs were met. Peop

Allied Care & Nursing provides personal care and support to people in their own homes.

The inspection was completed on 5 and 6 December 2016 and 11 January 2017. At the time of the inspection there were 27 people who used the service.

A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Quality assurance checks were not in place to enable the provider to assess and monitor the service in line with regulatory requirements or to improve the quality and safety of the service. The provider’s arrangements were not as robust as they should be as they had not recognised the issues we identified during our inspection. Improvements were required by the provider to ensure that all staff employed by the service received safeguarding training and suitable arrangements were in place to escalate concerns to the appropriate external agencies.

Proper recruitment checks had not been completed on all staff before they commenced working at the service and processes had not been operated in line with the provider’s own policy and procedures. Suitable arrangements were not in place to ensure that newly employed staff received suitable training opportunities, a robust induction, formal supervision and an annual appraisal of their overall performance.

Suitable control measures were not put in place to mitigate risks or potential risk of harm for people using the service as steps to ensure people and others health and safety were not always considered and risk assessments had not been developed for all areas of identified risk.

People told us that they were kept safe. Staffing levels were suitable to meet people’s needs. People told us that there had been no missed or late calls and only a few occasions where staff were late. People received their medicines at the times they needed them and people’s healthcare needs were managed well and they received appropriate nutrition and hydration each day according to their needs.

People spoke positively about the way staff treated them and reported that they received appropriate care and support. Staff demonstrated a good knowledge and understanding of the people they cared for and supported. People told us that their personal care and support was provided in a way which maintained their privacy and dignity. We found that people’s care plans reflected current information to guide staff on the most appropriate care people required to meet their needs.

You can see what actions we told the provider to take at the back of the full version of the report.